Acute Low Back Pain Management

Non-Pharmacological and Pharmacological Interventions

The American College of Physicians recommends avoiding the use of diazepam IM as first-line treatment for acute low back pain due to its limited efficacy and potential risks of sedation, tolerance, and dependence 1, 2
For acute low back pain, non-steroidal anti-inflammatory drugs (NSAIDs) have moderate evidence of efficacy with a better safety profile than benzodiazepines 4
The American College of Physicians suggests considering the addition of non-pharmacological therapies with proven benefits, such as spinal manipulation, if patients do not improve with self-care options 1, 2
For patients with acute low back pain who require medication, NSAIDs are recommended as first-line treatment due to their moderate evidence of efficacy and better safety profile than benzodiazepines 4
If a muscle relaxant is considered necessary, non-benzodiazepines may offer a more favorable risk-benefit profile 5

Benzodiazepines, including diazepam, are not approved by the FDA specifically for the treatment of low back pain (with or without radiculopathy) 2
Benzodiazepines appear to have similar efficacy to muscle relaxants for short-term pain relief but are associated with risks of abuse, addiction, and tolerance 2
The use of benzodiazepines is recommended to be limited in time if decided to be used 2

Central nervous system events, such as somnolence, fatigue, and dizziness, are reported more frequently with benzodiazepines than with placebo 3